Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Vena Cava Interruption


Related Terms

  • Insertion of Bird Cage Filter
  • Insertion of Greenfield Filter
  • Insertion of Vena Caval Umbrella
  • Interruption Inferior Vena Cava

Specialists

  • General Surgeon
  • Vascular Surgeon

Factors Influencing Duration

Factors that may influence the length of disability include the age and general health of the individual, location of the clot, another underlying medical or surgical condition, and the individual's previous history of emboli.

Medical Codes

ICD-9-CM:
38.7 - Interruption of the Vena Cava; Insertion of Implant or Sieve in Vena Cava; Ligation of Vena Cava (Inferior) (Superior); Plication of Vena Cava

Overview

A vena cava interruption is a surgical procedure designed to trap dislodged blood clots (thrombi) in the inferior vena cava (IVC), which is the large vein returning blood to the heart after it has circulated through the legs and lower torso. Trapping thrombi coming from these veins prevents them from traveling to the heart and then to the lungs, where they could cause a potentially fatal blockage of lung circulation (pulmonary embolism [PE]).

In the past, the procedure involved completely closing off (ligating) the IVC. This was a lengthy surgical procedure, often ineffective. Today, a much simpler and more effective method of vena cava interruption involves inserting a filtering device called a Greenfield, bird cage, or umbrella filter through a large vein in the leg or neck and positioning it in the IVC. The bird cage and umbrella filters resemble these objects in shape, but the umbrella filter looks like an umbrella without the material. These filters stop the large clots (thrombi) from traveling to the lungs.

Source: Medical Disability Advisor



Reason for Procedure

Conditions that may increase the risk of deep vein thrombosis (DVT) and PE and hence the need for this procedure include a history of cancer, a blood disorder called polycythemia vera, and changes in the levels of blood-clotting factors so that the blood becomes more likely to clot (hypercoagulability). Other risk factors for DVT and PE include prolonged sitting, bed rest, air travel, immobilization, recent surgery (especially hip surgery) or trauma, gynecological surgery, heart surgery, fractures of the pelvis or femur, and childbirth within the last 6 months.

Some common reasons for placing Greenfield filters in individuals at risk for PE include the inability to tolerate blood thinners (anticoagulants), the recurrence of pulmonary emboli despite treatment with anticoagulants, bleeding, low platelet count and other complications of anticoagulants, and DVT with free-floating clot (Jaff).

Vena cava interruption treats selected high-risk individuals with proven venous thromboembolism (VTE) and contraindications to anticoagulation (because of the risk of bleeding complications) or complications due to anticoagulation, and individuals who continue to have blood clots (recurrent VTE) even when given anticoagulants. Vena cava interruption is also used for individuals with multiple small pulmonary emboli that result in pulmonary insufficiency or pulmonary hypertension, for those with infected (septic) emboli and failure to improve after treatment with anticoagulants and antibiotics, and for individuals who have undergone previous surgery (pulmonary embolectomy) to remove a blood clot.

Source: Medical Disability Advisor



How Procedure is Performed

Insertion of a filter for vena cava interruption is usually performed using local anesthesia with intravenous injection of sedative. The area around the vein in the groin (femoral vein) or neck (jugular vein) is cleansed with a disinfectant solution, shaved if necessary, and numbed with local anesthetic. The vein is punctured and the device inserted through the vein using a long flexible tube (catheter). Using continuous x-ray (fluoroscopy) for guidance, the device is advanced and anchored in the large vein in the torso (inferior vena cava), where it will filter blood coming from the legs and lower torso to the heart and lungs. If the procedure is done on an outpatient basis, the individual is monitored for 6 to 12 hours and then allowed to return home.

Source: Medical Disability Advisor



Prognosis

Current methods of vena cava interruption are generally effective in reducing the short-term incidence of pulmonary emboli. See Complications.

Complications can occur early or late. About 0.1% of patients will die. Early complications that are related to the procedure include access site thrombosis (8.5%), device malposition (1.3%), pneumothorax (0.02%), hematoma (0.06%), air embolism (0.2%), inadvertent carotid artery puncture (0.04%), and arteriovenous fistula (0.02%). Late complications include recurrent DVT (21%), IVC thrombosis (2–10%), IVC penetration (0.3%), and filter migration (0.3%) (Jaff).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Possible work restrictions and accommodations include decreased work activity, extended leave, and increased rest periods. The individual should avoid driving or operating machinery for 24 hours, strenuous exercise or lifting for 2 days, and prolonged standing or sitting for 1 to 4 weeks following the operation. Temporary reassignment to work that complies with these restrictions may be necessary. Individuals take anticoagulants for 3 to 6 months.

Risk: Patients who require chronic anticoagulation may be precluded from jobs requiring work at unprotected heights or a high risk of trauma. For patients with DVT as the cause of the filter placement, freedom of movement that prevents prolonged sitting or prolonged standing may be helpful.

Capacity: Should not be impaired once treated, though exercise treadmill test may help verify the abilities.

Tolerance: Jobs that allow more freedom of movement may be more conducive to a return to work. Those who had DVT as the indication for their filter may benefit from the use of support stockings.

Source: Medical Disability Advisor



Maximum Medical Improvement

90 days.

Source: Medical Disability Advisor



References

Cited

Jaff, M. R. , et al. "Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension: A Scientific Statement from the American Heart Association." Circulation 123 (2011): 1788-1830.

Source: Medical Disability Advisor






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